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Early pregnancy care, booking, screening and knowing when to call the EPAU.

The first 14 weeks set the tone for the rest of pregnancy. This is the UK plan - booking bloods, dating scan, combined screen and safe care for the common problems.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE, RCOG and NHS antenatal standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including NIPT on the NHS since 2021 and updated vaccination advice.

Key facts

The first trimester at a glance.

The essentials, in plain English - what the booking journey looks like and the red flags to know from the outset.

  • What it is

    The care and screening offered in the first 14 weeks of pregnancy - booking bloods, dating scan and combined screen.

  • Booking window

    Ideally at 8 to 10 weeks with a midwife - earlier if there is a medical or obstetric risk factor.

  • Dating scan

    Between 11 and 14 weeks - confirms viability, dates the pregnancy and forms the combined Down's screen.

  • Miscarriage

    Affects roughly 10 to 20 per cent of clinical pregnancies - most first-trimester bleeding is assessed by an EPAU.

  • Folic acid

    400 micrograms daily preconception and through the first 12 weeks; 5 milligrams if high risk.

  • Emergency care

    Severe pain, heavy bleeding, shoulder-tip pain or collapse needs same-day EPAU or A&E review.

Why this guide matters

A calm map through the first 14 weeks.

Most first-trimester questions come down to three things - what tests you are offered, what is normal, and when to seek urgent help. This page covers all three.

  • Book early, screen well

    Booking at 8 to 10 weeks makes room for informed screening choices and a dating scan by 14 weeks.

  • Bleeding needs an EPAU

    Any first-trimester bleeding or pain deserves a scan and serum hCG - your GP or midwife can refer directly.

  • Emergency until proven otherwise

    Severe unilateral pain, shoulder-tip pain or collapse is an ectopic pregnancy until proven otherwise - attend A&E.

How early pregnancy care unfolds

From positive test to a settled antenatal plan.

The steps a UK GP, midwife or EPAU will normally follow in the first trimester - in order.

  1. 01

    Confirming

    Confirm the pregnancy

    A urine hCG test at home or with the GP confirms the pregnancy - date from the first day of the last menstrual period.

  2. 02

    Confirming

    Book with a midwife

    Refer to community midwifery for a booking appointment at 8 to 10 weeks - earlier for high-risk histories.

  3. 03

    Confirming

    History and risk assessment

    LMP, cycle regularity, contraception, medical and obstetric history, medications, folic acid, smoking, alcohol and occupation.

  4. 04

    Screening

    Booking bloods

    FBC, haemoglobinopathy screen, blood group and Rh D, rubella immunity, syphilis, hepatitis B, HIV and selective toxoplasmosis.

  5. 05

    Screening

    Dating and combined screen

    Ultrasound at 11 to 14 weeks - crown-rump length dates the pregnancy and nuchal translucency plus bHCG and PAPP-A gives the combined risk.

  6. 06

    Escalating

    NIPT when indicated

    Non-invasive prenatal testing is offered on the NHS after a higher-chance combined result since 2021 - and is available privately from earlier gestations.

  7. 07

    Escalating

    Specialist referral

    Any bleeding, pain or concern in the first trimester goes to an early pregnancy assessment unit (EPAU) for scan and serum hCG.

Typical timeline: positive test to dating scan in around 10 weeks.

Symptoms

What the first trimester feels like.

Presentation ranges from asymptomatic to bleeding, pain and hyperemesis - and every version in between is normal for someone.

  • Missed period and positive test

    Often the first sign - a home urine hCG becomes positive within days of a missed period.

  • Nausea and vomiting

    Common from 6 weeks and usually settles by 14 to 16 weeks - severe forms can become hyperemesis gravidarum.

  • Breast tenderness and fatigue

    Hormonal effects of rising hCG and progesterone - reassuring rather than concerning.

  • Light spotting

    Around 20 per cent of pregnancies bleed in the first trimester - most continue normally but always warrants an EPAU review.

  • Cramping and pelvic discomfort

    Mild stretching pain is normal - severe, one-sided or persistent pain needs same-day assessment.

  • Hyperemesis features

    Persistent vomiting, weight loss, dehydration and ketosis - admission for IV fluids and antiemetics is often needed.

  • Asymptomatic pregnancy

    Many women feel very little in early pregnancy - this is not a sign of miscarriage on its own.

  • Red flag - heavy bleeding or shoulder pain

    Heavy PV bleeding, severe unilateral pain, shoulder-tip pain or collapse - suspect ectopic and attend A&E urgently.

Treatment

How early pregnancy is cared for in the UK.

Preventive care and supplements first, then targeted management of sickness, bleeding, ectopic pregnancy and rarer complications through midwifery, EPAU and specialist tertiary centres.

  • Folic acid supplementation

    400 micrograms daily preconception and through the first 12 weeks - 5 milligrams if epilepsy, diabetes, previous NTD, BMI over 30 or sickle cell.

  • Vitamin D

    10 micrograms daily throughout pregnancy - especially important for darker skin tones and covered dress.

  • Medication review

    Stop or switch teratogenic medications early - isotretinoin, methotrexate, warfarin, sodium valproate and ACE inhibitors need specialist input.

  • Antiemetics for sickness

    Cyclizine, prochlorperazine, ondansetron or doxylamine/pyridoxine (Xonvea) - steroids reserved for severe hyperemesis.

  • EPAU assessment

    Transvaginal ultrasound and serial serum bHCG for bleeding, pain or uncertain viability - shared decisions on expectant, medical or surgical care.

  • Miscarriage management

    Expectant, medical (misoprostol) or surgical management including manual vacuum aspiration - see /treatments/mva-manual-vacuum-aspiration/.

  • Ectopic pregnancy treatment

    Methotrexate for suitable stable cases or laparoscopic salpingectomy/salpingotomy - emergency surgery if unstable.

  • Vaccinations in pregnancy

    Influenza, pertussis (from 20 weeks) and COVID-19 are all recommended by the NHS - protective for parent and baby.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your midwife, GP or obstetrician knows your history and pregnancy and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Antenatal care (NG201).

  • NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management (NG126).

  • Royal College of Obstetricians and Gynaecologists (RCOG). Green-top guidelines on early pregnancy loss and hyperemesis gravidarum.

  • NHS England. NIPT for Down's, Edwards' and Patau's syndromes on the NHS Fetal Anomaly Screening Programme (since 2021).

  • UK Health Security Agency. Vaccination in pregnancy: flu, pertussis and COVID-19.

Red flags

When early pregnancy needs urgent care.

Most first-trimester symptoms are manageable. These are the ones where the EPAU or A&E should hear from you today.

  • Heavy PV bleeding

    Soaking pads with clots - attend an early pregnancy assessment unit or A&E the same day for scan and bloods.

  • Severe unilateral pelvic pain

    Especially with a positive test and bleeding - assume ectopic pregnancy until proven otherwise.

  • Shoulder-tip pain or collapse

    Suggests intra-abdominal bleeding from a ruptured ectopic - call 999 or attend A&E immediately.

  • Uncontrolled vomiting and dehydration

    Ketosis, weight loss and inability to keep fluids down - hyperemesis needs admission for IV fluids and antiemetics.

  • Very high hCG or grape-like tissue

    Consider gestational trophoblastic disease - referral to a UK tertiary centre (Charing Cross, Weston Park or Ninewells).

  • Signs of infection

    Fever, offensive discharge or systemic upset with bleeding - possible septic miscarriage; urgent gynaecology review.

  • Teratogen exposure

    Isotretinoin, methotrexate, warfarin, sodium valproate or ACE inhibitors - urgent specialist review and switch to safer options.

  • Mental health crisis

    Perinatal low mood, anxiety or thoughts of self-harm - perinatal mental health services and crisis lines are there for you.

  • VTE symptoms

    Calf swelling, chest pain or breathlessness - pregnancy raises clot risk from the first trimester; same-day review.

Living with it

Small habits, big first-trimester payoff.

Four things that make the biggest difference in the first 14 weeks - supplements, food safety, stopping smoking and alcohol, and knowing when to phone the EPAU.

A quiet reminder

You do not have to figure it out alone.

Midwives, GPs and early pregnancy units are used to every question, worry and complication of the first trimester.

  1. 01 Routine

    Take folic acid and vitamin D

    Small daily habits with the biggest evidence base - 400 micrograms of folic acid and 10 micrograms of vitamin D.

  2. 02 Food

    Eat safely, not restrictively

    Avoid unpasteurised dairy, soft cheeses, undercooked meat and raw eggs - protects against listeriosis, toxoplasmosis and salmonella.

  3. 03 Lifestyle

    Stop smoking and alcohol

    The first trimester is when organs form - stopping now is the single biggest thing you can do for a healthy pregnancy.

  4. 04 Escalate

    Know when to phone the EPAU

    Bleeding, one-sided pain, shoulder-tip pain, uncontrolled vomiting or feeling very unwell - the early pregnancy unit is there for exactly this.

Frequently asked

Everything we get asked about early pregnancy.

Quick answers on booking, screening, miscarriage, ectopic pregnancy and vaccinations.

  • When should I book my first midwife appointment?

    Aim for 8 to 10 weeks of pregnancy. Booking early gives time for blood tests, screening choices and any medication changes before the dating scan at 11 to 14 weeks. Contact your GP or self-refer to community midwifery as soon as you have a positive pregnancy test.

  • What is the combined screen and do I have to have it?

    The combined screen is an optional test between 11 and 14 weeks that estimates the chance of Down's, Edwards' and Patau's syndromes. It uses the nuchal translucency measurement at the dating scan plus two blood markers (bHCG and PAPP-A). It is your choice - many parents accept, some decline.

  • Is NIPT available on the NHS?

    Yes. Since 2021 NIPT has been offered on the NHS after a higher-chance combined screen result. It is a very accurate blood test that looks at cell-free fetal DNA. NIPT is also widely available privately from around 10 weeks for those who want it earlier.

  • How common is miscarriage?

    Around 10 to 20 per cent of clinically recognised pregnancies end in miscarriage, most within the first 12 weeks. This is almost always due to a chromosomal problem in the pregnancy rather than anything the parent did or did not do. Bleeding or pain should be assessed by an early pregnancy assessment unit.

  • How do I tell miscarriage from ectopic pregnancy?

    You cannot reliably tell them apart at home - both can cause bleeding and pain. Severe one-sided pelvic pain, shoulder-tip pain, feeling faint or collapse suggests ectopic pregnancy, which is a medical emergency. Any bleeding or pain in early pregnancy needs same-day EPAU or A&E review.

  • Which vaccinations are safe in early pregnancy?

    The NHS recommends the flu vaccine at any stage of pregnancy, pertussis (whooping cough) from around 20 weeks, and COVID-19 vaccines including boosters. Live vaccines such as MMR are usually avoided in pregnancy. Always discuss travel or occupational vaccinations with your midwife or GP.

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